What do Cochrane systematic reviews say about non-surgical interventions for urinary incontinence in women?

BACKGROUND: Urinary incontinence is a highly prevalent condition that impacts self-esteem and overall quality of life. Many non-surgical treatment options are available, ranging from pharmacological approaches to pelvic exercises. We aimed to summarize the available evidence regarding these non-surgical interventions. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM-UNIFESP). METHODS: A sensitive search was conducted to identify all Cochrane systematic reviews that fulfilled the inclusion criteria. Titles and abstracts were screened by two authors. RESULTS: We included 20 Cochrane systematic reviews: 4 assessing methods of vesical training, 3 evaluating pharmacological interventions, 4 studying pelvic floor muscle training approaches and 9 aimed at other alternatives (such as urethral injections, weighted vaginal cone use, acupuncture, biostimulation and radiofrequency therapy). The reviews found that the evidence regarding the benefits of these diverse interventions ranged in quality from low to high. CONCLUSIONS: This review included 20 Cochrane systematic reviews that provided evidence (of diverse quality) for non-pharmacological interventions for patients with urinary incontinence. Moderate to high quality of evidence was found favoring the use of pelvic floor muscle training among women with urinary incontinence. To establish solid conclusions for all the other comparisons, further studies of good methodological quality are needed.Univ Fed Sao Paulo Unifesp, Escola Paulista Med, Discipline Evidence Based Hlth, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Dept Gynecol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Discipline Evidence Based Hlth, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Dept Gynecol, Sao Paulo, SP, BrazilWeb of Scienc

Assessing the Impact of Twin Pregnancies on the Pelvic Floor Using 3-Dimensional Sonography A Pilot Study

Objectives-The purpose of this study was to compare the morphologic characteristics of the pelvic floor musculature between women with twin and singleton pregnancies.Methods-We conducted a cross-sectional case-control study of 40 nulliparous women aged 20 to 38 years to compare women with singleton pregnancies (n = 23) to women with twin pregnancies (n = 17). Biometric measurements of the levator hiatus and the sagittal and coronal diameters were made by transperineal 3-dimensional sonography between the 28th and 38th gestational weeks. Comparisons were statistically assessed by the unpaired Student t test and Mann-Whitney U test.Results-For the women with singleton pregnancies, the mean sagittal diameters at rest, during the Valsalva maneuver, and during pelvic floor contraction were 5.3, 5.7, and 4.5 cm, respectively, and the mean coronal diameters under these conditions were 3.8, 4.1, and 3.6 cm. for the women with twin pregnancies, the corresponding values were as follows: mean sagittal diameters, 5.3, 5.8, and 4.6 cm; and mean coronal diameters, 4.3, 4.3, and 3.8 cm. the differences in coronal diameters were statistically significant at rest (P < .01) and during contraction (P = .04). the mean levator hiatal areas for the women with singleton pregnancies were 14.6, 16.9, and 11.7 cm(2) at rest, during Valsalva, and during contraction, respectively; for the women with twin pregnancies, these values were 16.0, 18.6, and 12.6 cm(2).Conclusions-Hiatal measurements were higher in twin than in singleton pregnancies, with coronal diameters reaching significance at rest and during contraction, suggesting that pelvic support undergoes greater changes during twin pregnancy.Universidade Federal de São Paulo, Dept Obstet, Pelv Floor Sect, BR-05303000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, Pelv Floor Sect, BR-05303000 São Paulo, BrazilWeb of Scienc

Influence of body mass index, body fat percentage and age at menarche on aerobic capacity (VO2 max) of elementary school female students

PURPOSE:To identify and relate body fat percentage (skin fold measures), body mass index (BMI) and age at menarcheto aerobic capacity using the indirect VO2 maximum value (VO2 max) of girls in the second cycle of primary school.METHODS:A total of 197 girls aged 13.0±1.2 years on average, students from two public schools in the city of Atibaia in São Paulo, were evaluated. Anthropometric evaluation of skin folds was performed using the Slaughter protocol for teenage girls, and BMI (kg/m2) was based on Z score (graphic of percentile) according to WHO recommendations. The Léger protocol was used to determine VO2 max. Pearson linear regression and the Student t-test were used for statistical analysis.RESULTS:22.3% of the girls were overweight and 3.5% were obese according to the classification proposed by the WHO; 140 (71.1%) girls reported menarche. The average age at menarche was 12.0±1.0 years and was significantly higher in the group with normal BMI (12.2±0.9 years) than in the overweight or obese groups (11.6±1.0 years). The average indirect VO2 max value was 39.6±3.7 mL/kg/min, ranging from 30.3 to 50.5 mL/kg/min. The advance of chronological age and early age at menarche were positively correlated with lower VO2 max values.CONCLUSIONS:This study showed that 25.8% of the girls had aBMI value above WHO recommendations. Girls with higher BMI and higher body fat percentage had lower VO2 max. The earlier age at menarche and the advance of chronological age were the most important factors for the reduction of aerobic capacity. The ageat menarche was higher in girls with adequate BMI compared tooverweight or obese girls.OBJETIVO:Identificar e relacionar a composição corporal, baseada na porcentagem de gordura corporal e o índice de massa corpórea (IMC), e a idade da menarca, com a capacidade aeróbia, utilizando-se os valores de VO2 máximo indireto, de estudantes do segundo ciclo do ensino fundamental.MÉTODOS:Foram avaliadas 197 meninas com média de idade de 13,0±1,2 anos, estudantes de duas escolas estaduais de Atibaia-SP. Para estimar a porcentagem de gordura corporal, foi realizada uma avaliação de dobras cutâneas utilizando-se o protocolo de Slaughter para meninas adolescentes. Já o índice de massa corpórea (IMC), medido em quilogramas por metro quadrado (kg/m2), seguiu as recomendações da Organização Mundial da Saúde (OMS). Para a avaliação aeróbia, foi utilizado o teste de corrida proposto por Léger, determinando o volume de oxigênio máximo de forma indireta (VO2 máx). Para a análise estatística, foi utilizada a regressão linear de Pearson, o teste t de Student e a análise multivariada.RESULTADOS:22,3% das meninas apresentaram sobrepeso e 3,5% obesidade, de acordo com o IMC. Na amostra estudada, 140 (71,1%) adolescentes relataram a ocorrência de menarca. A média de idade da menarca foi de 12,0±1,0 anos. A média de idade de menarca para o grupo com IMC normal foi significativamente maior (12,2±0,9 anos) do que nas estudantes com sobrepeso ou obesidade (11,6±1,0 anos). A média do VO2 máx indireto foi de 39,6±3,7 mL/kg/min, variando de 30,3 a 50,5 mL/kg/min. O avanço da idade cronológica e a precocidade da menarca correlacionaram-se positivamente com os menores valores de VO2 máx.CONCLUSÕES:Meninas com maiores valores de IMC e percentual de gordura corporal apresentaram menores valores de VO2 máx. A precocidade da menarca e o avanço da idade cronológica foram os fatores mais importantes para a redução da capacidade aeróbia. A idade da menarca foi mais elevada em meninas com IMC adequado quando comparadas com as meninas com sobrepeso ou obesidade.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de GinecologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de OtorrinolaringologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPM, Depto. de GinecologiaUNIFESP, EPM, Depto. de OtorrinolaringologiaUNIFESP, EPMSciEL

Medical residency in gynecology and obstetrics in times of COVID-19 : recommendations of the National Specialized Commission on Medical Residency of FEBRASGO

* Text prepared by the members of the National Specialized Commission on Medical Residency and endorsed by the Scientific Board and Presidency of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO)

Role of estrogen receptor alpha on vaginal epithelialization of patients with Mayer-Rokitansky-Kuster-Hauser syndrome submitted to neovaginoplasty using oxidized regenerated cellulose

Introduction and hypothesis the purpose of this study was to evaluate the expression of estrogen receptor alpha (ER alpha) on the neovaginal tissue of patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome submitted to modified Abbe-McIndoe neovaginoplasty using oxidized regenerated cellulose.Methods the current study involved eight subjects with MRKH syndrome. Serial samples of the neovagina were obtained after the surgery and immunohistochemical detection of ER alpha was performed using antibody NCL-L-ER-6F11.Results the operation was performed successfully in all subjects without complications. A total of 22 samples of neovaginal tissue were analyzed. the expression of ER alpha was detected only 6 months after the surgery, when the neovagina acquired characteristics of normal vagina.Conclusion in our study, the expression of ER alpha occurred when complete epithelialization of vaginal tissue was ob-served. Other mechanisms may be involved in the formation of vaginal epithelium in patients with MRKH syndrome.Universidade Federal de São Paulo, Sect Urogynecol & Pelv Surg, Dept Gynecol, BR-04025001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Sect Urogynecol & Pelv Surg, Dept Gynecol, BR-04025001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pathol, BR-04023900 São Paulo, BrazilWeb of Scienc

Incidence of Bacteriuria after Urodynamic Study with or without Antibiotic Prophylaxis in Women with Urinary Incontinence

Introduction The presence of bacteria in urine is called bacteriuria, which may be symptomatic or asymptomatic. The manipulation of the urinary tract during urodynamic study (UDS), which is an invasive procedure, can result in urinary tract infection (UTI). Studies on the use of prophylactic antibiotics for UDSs are contradictory. Some investigators concluded that they were valuable and others did not. The objective of this study is to evaluate the efficacy of antibiotic prophylaxis before UDS. This is a placebo-control randomized double-blind study. Methods Two-hundred and seventeen women affected by urinary incontinence were eligible for this study. All patients had presented negative urine culture previous to the UDS. They were randomized in four groups: group A received placebo, group B received 500 mg of levofloxacin, group C received 80 mg trimethoprim and 400 mg sulfamethoxazole and group D received 100 mg of nitrofurantoin. A urine culture was performed 14 days after the UDS. Results We observed asymptomatic bacteriuria after the UDS in five patients in group A, one in group B, one in group C and one in group D. Only one patient on group A had symptomatic bacteriuria. We didn't observe statistical difference between the groups. When we recategorized the patients in two groups, the incidence of bacteriuria was significantly higher in the placebo group compared with the antibiotic group. Conclusion The conclusion is that antibiotic prophylaxis before the UDS did not reduce the incidence of UTI in women within the target population.Univ Fed Sao Paulo, Dept Gynecol, Rua Dom Constantino Barradas 45,Apto 151, BR-04134110 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Gynecol, Rua Dom Constantino Barradas 45,Apto 151, BR-04134110 Sao Paulo, SP, BrazilWeb of Scienc

Evaluation of Demographic, Clinical Characteristics, and Genetic Polymorphism as Risk Factors for Pelvic Organ Prolapse in Brazilian Women

Objective: Verify the association between genital prolapse, other risk factors and a polymorphism in exon 31 of the collagen III-a1 gene (COL3A1). Setting: the etiology of genital prolapse is multifactorial, and genetic defects have been proposed. Also, there is evidence that changes in collagen may be responsible for defects in pelvic floor support. the exon 31 polymorphism results in structural changes in the triple helical of the collagen and appears to lead to abnormal synthesis of type III collagen. Design: Basic science study. Population: the studied group consisted of 107 patients with stage III and IV genital prolapse (POP-Q). the control group included 209 women with stage 0 and I prolapse. Methods: After extracting genomic DNA from the peripheral blood, the exon 31 COL3A1 polymorphism was typed by restriction fragment length polymorphism analysis. Main outcome measures: Association between genital prolapse and exon 31 COL3A1 polymorphism. Results: No statistically significant differences in genotype and allele frequencies were found between cases and controls (P = 0.75 and 0.66, respectively). Multiple logistic regression analyses identified age (OR = 1.05; 95% CI = 1.01-1.10), BMI (OR = 1.09; 95% CI = 1.01-1.17), presence of at least one vaginal delivery (OR = 7.22; 95% CI = 1.84-28.27), positive family history of POP (OR = 2.27; 95% CI = 1.05-4.93) and a macrosomic foetus (OR = 2.91; 95% CI = 1.24-6.79) as independent risk factors for genital prolapse. in contrast, the number of caesarean deliveries was found to be an independent protective factor (OR - 0.43; 95% CI - 0.24-0.78). Conclusions: the type III collagen exon 31 polymorphism is not a risk factor for pelvic genital prolapse in this sample. Neurourol. Urodynam. 30:13251328, 2011. (C) 2011 Wiley-Liss, Inc.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Sect Urogynecol & Pelv Surg, Dept Gynecol, São Paulo, BrazilUniv Fed Minas Gerais, Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo, Sect Urogynecol & Pelv Surg, Dept Gynecol, São Paulo, BrazilWeb of Scienc